Laurin Kasehagen, MA, PhD MCH Epidemiologist / CDC Assignee to CityMatCH Maternal & Child Health Epidemiology Program Applied Sciences Branch, Division of Reproductive Health National Center for Chronic Disease Prevention & Health Promotion 1

Workshop Objectives  Locate and obtain data on child health and school readiness from national surveillance systems  Explain some limitations of local level data and how these limitations can affect conclusions  Describe ways in which outcomes for cities and counties differ from each other and from state / national outcomes  Provide hands-on opportunity to work with surveillance data 2

Introduction & Overview  Importance of local data  Introduction to local data sources  What’s available  How to use it  Advantages and limitations of these data sources  How city/county level outcomes differ from state/national level outcomes 3

Why is local data important?  “.... [Such] data are  essential in identifying communities most at risk of poor health outcomes,  exploring the determinants of such variations in health, and  ultimately guiding community health programs and policies.”  From: Shah, Whitman & Silva in “Variations in the Health Conditions of 6 Chicago Community Areas: A Case for Local-Level Data” 4

Misperceptions about local- level data  Not available  Not accessible  Too difficult to use  Don’t have what I need 5

Table 1. National Surveillance Systems and Surveys of Infant & Child Populations Survey Name Age Range Survey Purpose Survey Interval Local Level? Pediatric Nutrition Surveillance System (PedNSS) 0-5 years* describes the nutritional status of low- income children attending federally- funded MCH / nutrition programs Routinely, annually Yes** National Immunization Survey (NIS) months estimates of vaccination coverage rates for all childhood vaccinations recommended by the ACIP‡ AnnuallyYes^ National Survey of Children’s Health (NSCH) # 0-17 years examines the physical and emotional health of children, including medical homes, family interactions, parental health, school and after-school experiences, and neighborhoods Every 4 years Yes^£ National Survey of Children with Special Health Care Needs (NS-CSHCN) # 0-17 years assesses the prevalence and impact of special health care needs among children Every 4 years Yes^£ Pregnancy Risk Assessment Monitoring System (PRAMS) <6 months Collects data on maternal attitudes and experiences before, during, and shortly after pregnancy AnnuallyYes** National Health and Nutrition Survey † <18 years assesses the health and nutritional status Routinely, annually Yes** National Health Interview Survey (NHIS) † <18 years assesses amount, distribution, and effects of illness / disability and the services rendered for / because of the conditions Routinely, annually Yes** * some data on 0-20 years; ** access to local level data through local WIC agencies / local health department or state health department; # survey samples both children and youth with special health care needs as well as a smaller sample of children and youth without special health care needs; ‡ Advisory Committee on Immunization Practices (ACIP); ^ access to local level data by written request to National Center for Health Statistics; data for MSA/non-MSA and broad rural / urban categories is publically available; £ on-line, interactive CAHMI web-site provides data by Rural Urban Community Area taxonomy for urban core, suburban, large town, and small town/rural geographic categories; † surveys at the household level of both adults and children 6

Table 2. National Surveillance Systems and Surveys of Adolescent & Adult Populations Survey NameSurvey Purpose Survey Interval Local Level? Youth Risk Behavior Surveillance System (YRBSS) monitors priority health-risk behaviors and the prevalence of obesity and asthma among youth and young adults Annually Only for certain large school districts National Survey of Family Growth (NSFG) gathers information on family life, marriage and divorce, pregnancy, infertility, use of contraception, and men's and women's health PeriodicYes^ Pregnancy Surveillance System (PNSS) monitors risk factors associated with infant mortality and poor birth outcomes among low-income pregnant women who participate in federally funded public health programs Routinely, annually Yes** Pregnancy Risk Assessment Monitoring System (PRAMS) collects state-specific, population-based data on maternal attitudes and experiences before, during, and shortly after pregnancy AnnuallyYes** Behavioral Risk Factor Surveillance System (BRFSS) collects information on health risk behaviors, preventive health practices, and health care access primarily related to chronic disease and injury AnnuallyYes ^ access to local level data by written request to National Center for Health Statistics; data for MSA/non-MSA and broad rural / urban categories is publically available ** access to local level data through local WIC agencies / local health department or state health department 7

Table 3. Laurin’s Favorite On-line Interactive Websites and Web Portals WebsiteUnique Website Feature(s) PeriStats --  city, county, state, national maternal and infant health data Premature Birth Report Card; PubMed literature search feature; indicators; map feature CAHMI --  portal to the Data Resource Center for the NSCH and the NS-CSHCN  quality measurement tools and strategies that assess the quality of care Quality measurement tools and strategies; examples of applications of CAHMI tools and data use; mental health chartbooks; medical home portal; SSI data Community Health Data Initiative --  national initiative to help consumers and communities to access health data in usable formats and to encourage effective efforts in disease prevention, health promotion, and measurement of health care quality and performance Publically available data and tools with rating of data / tool Health Data Interactive --  tables with national health statistics for infants, children, adolescents, adults, and older adults Tables can be customized by age, gender, race/ethnicity, and geographic location to explore different trends and patterns Health Indicators Warehouse --  over 1100 indicators by topic, geography, and initiative  portal to initiatives and data sources Indicator mapping by state, county or hospital referral region; comprehensive data source resource list Community Health Status Indicators --  key health indicators for local communities (3141 US counties) Ability to select county of interest and peer counties (counties of similar population size and frontier status) NRCCWDT – National Resource Center for Child Welfare Data and Technology  assists state, local and tribal child welfare agencies and the courts in improving outcomes for children and families through the use of data and information technology Toolkits; training on using information and data in planning and measuring progress National Center for Environmental Health --  portal to nationally funded environmental public health data systems Links to and descriptions of major data systems with a national scope where public health and environmental data can be downloaded 8

WOW! There are a lot of different data sources! Where do I start?  Known Data Source  Topic  Initiative / Indicator  Existing indicators linked to data sources  Geography 9

Table 4. Council of State and Territorial Epidemiologists (CSTE) Indicator Resources Chronic DiseaseChronic Disease Indicators Environmental Health CDC/NECH Environmental Public Health Indicators Project Environmental Public Health Indicators InjuryState Injury Indicators Report: Fourth Edition Maternal and Child HealthCore State Preconception Indicators Occupational Health Occupational Health Indicators: A Guide for Tracking Occupational Health Conditions and Their Determinants Note: To access these resources and publications go to the CSTE website:

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Ways to measure the health of children under 10 years of age  Healthy People 2020  42 Topic Areas  1,412 Objectives  262 are developmental objectives  Over 160 HP2020 objectives relate to children  Maternal, Infant, and Child Health  Early and Middle Childhood  Immunization and Infectious Diseases  Nutrition and Weight Status  Oral Health  Physical Activity  Local-level data is not available for all of these objectives 12

Finding Local-Level Data Examples  HealthyPeople.gov   Mental Health Status Improvement  HP2020 Objective MHMD-6: Treatment for children with mental health problems  Maternal, Infant, and Child Health  HP2020 Objective MICH-30: Increase the proportion of child, including those with special health care needs, who have access to a medical home  Early and Middle Childhood  HP2020 Objective EMC-2.3: Increase the proportion of parents who read to their young child 13

HP2020 Objective MHMD-6: Treatment for children with mental health problems; Data compiled at the Health Indicators Warehouse from the 2008 National Health Interview Survey 68.90% (62.70%, 75.10%) 82.51% (74.84%, 90.19%) 57.97% (48.79%, 67.15%) 14

Is there local- level information on reading to young children? Website: accessed 07/26/

Data on reading to young children is available on-line at the national, regional, state levels 16

On-line data can be looked at and compared through a number of different subgroups 17

How can you tell whether the statistic that you have is significant? 18

How can you tell whether the statistic that you have is significant? 19

Community Health Status Indicators Comparison of Peer Counties: Risk Factors for Premature Death Boone County, MODeschutes County, OR Santa Fe County, NM 20

Why is local-level data so hard to get?  Data may not be collected at the household, city, or county level  e.g., some national and state surveys collect data only for large metropolitan areas, or select a few areas to represent all  Data may be reported only for jurisdictions with populations of 100,000 or more  For smaller jurisdictions, data may be aggregated 21

If you do get your hands on local data, what do you need to watch out for?  Confidentiality  e.g., “Hey look, this dataset has a family of 12 kids, including 3 sets of twins! I’ll bet that’s the Smiths from down the street. Whoa, it says here that Mrs. Smith only has an 8 th grade education.”  Rare events / small numbers of “events” (death, birth defects)  limited statistical power  several years may need to be combined 22

National, state, or MMSA level data may not capture events at the local level 23

Small populations / rare events in a population can produce dramatic, erratic results 24

Other concerns about data...  Where did the numbers came from?  a source that collects information on ALL of the population (e.g. Census, Vital Records)  a representative sample of the population  a convenience sample of some people  Quality of data is affected by practices related to  Recording  Collecting  Reporting  Potential sources of data differ greatly per type of event – deaths, injuries, illnesses require complex surveillance systems 25

Limitations: How well do county data represent city populations?  Some public health issues that affect cities will not be accurately represented using county-level data  Generally, counties are larger geographical areas that also include suburban and even rural areas  Some large cities are spread over several counties  Some counties do not include their urban central city 26

Evidence-Based Practice for Public Health 27

The Community Guide (CDC) 28

Health Policy Guide 29

PHPartners 30

YOU can put the pieces together  National vital records and state survey data provide broad context  “Where do we stand?”  Local survey and subpopulation data allow us to dig deeper  “What are underlying causes?”  Local investigation and action  “What do we know about our systems, our communities?” 31

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CityMatCH Mission Improving the health and well-being of urban women, children and families by strengthening public health organizations and leaders in their communities 33

References  Shah, Whitman & Silva. Variations in the Health Conditions of 6 Chicago Community Areas: A Case for Local-Level Data. Am J Public Health 96(8): (2006).  Brownson, et al. Evidence-Based Decision-Making in Public Health. J Public Health Manag Prac 5:86-87 (1999).  The Cochrane Collaboration;  Association of Maternal and Child Health Programs (AMCHP) Best Practices; es/default.aspx es/default.aspx  National Association of City and County Health Officials;

Contact Information Laurin Kasehagen, PhD, MA Senior MCH Epidemiologist / CDC Assignee to CityMatCH CityMatCH at the University of Nebraska Medical Center Department of Pediatrics Nebraska Medical Center Omaha, NE